Interdisciplinary and Multidisciplinary Approaches to Orofacial Pain Care

  • Shawn McMahonEmail author


  • Biomedical and biopsychosocial models are two approaches to health care that have been proven effective when utilized in the appropriate situation. Health-care providers must understand that chronic pain is a disease of the person and that a traditional biomedical approach cannot adequately address all of the individual pain-related physiological, psychological, and social needs of this patient population.

  • Chronic pain patients generally present with complex, multimodal problems that often involve two or more coexisting chronic pain conditions (e.g., chronic headaches, chronic fatigue syndrome, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, vulvodynia, and gastric reflux disease). They often describe disturbed sleep, increased stress, anxiety, depression, and even anger resulting in a decreased quality of life. With so many overlapping factors, it makes sense that current literature supports a “whole person” approach to chronic pain diagnosis and management.

  • Current literature describes various models to address chronic pain using a multimodal approach. Although they differ in areas such as organization, structure, format, and cost, they do have common core features:
    • A biopsychosocial approach to diagnosis and care that not only addresses the associated biology but also the psychological and social aspects of the pain condition

    • Providers from multiple disciplines working in an integrated fashion with shared treatment goals

    • Goals: to reduce effects of pain, improve function, and achieve independence from the health-care system

  • Multidisciplinary care involves care provided by health-care providers from several disciplines which may, or may not, be coordinated, and treatment may occur with different goals in parallel rather than an integrated approach.

  • Interdisciplinary care involves a team of health-care providers from different specialties that play complementary roles that when implemented together enhance patient care.


Disclosure Statement by the Author

The opinions or assertions contained herein are the private ones of the author(s) and are not to be construed as official or reflecting the view of the DoD or the USUHS. The author does not have any financial interest in the companies whose materials are discussed in this article.


  1. 1.
    De Leeuw R, Klasser G. In: de Leeuw R, editor. Orofacial pain guidelines for assessment, diagnosis, and management. Hanover Park: Quintessence Books; 2013.Google Scholar
  2. 2.
    Dworkin S, Massoth D. Temporomandibular disorders and chronic pain: disease or illness? J Prosthet Dent. 1994;72:29–38.CrossRefPubMedGoogle Scholar
  3. 3.
    Verhoef M, O’Hara D, Findlay B, Boon H. From parallel practice to integrative health care: a conceptual framework. BMC Health Serv Res. 2004;4:15.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Price SD, Crawford GB. Team working: palliative care as a model of interdisciplinary practice. MJA. 2003;179(suppl):S32–4.PubMedGoogle Scholar
  5. 5.
    Turk D, Paice J, Cowan P, Stanos S, Jamison R, Covington E, Palermo T, Gordon D, Clark M. Interdisciplinary pain management, American Pain Society - Position Statement (White Paper): American Pain Society, 4700 W. Lake Avenue, Glenview, IL 60025; 2009.Google Scholar
  6. 6.
    Fricton J. Untitled paper on interdisciplinary model of care for chronic pain patients, Minneapolis: unpublished. 2005.Google Scholar
  7. 7.
    Carlson CR. Psychological factors associated with orofacial pains. Dent Clin North Am. 2007;51:145–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Pace-Schott EF, Stickgold R, Otto MW, Jacobs GD. Cognitive behavior therapy and pharmacotherapy for insomnia. Arch Intern Med. 2004;164:1888–96.CrossRefPubMedGoogle Scholar
  9. 9.
    Sessle B. Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates. Crit Rev Oral Biol Med. 2000;11(1):57–91.CrossRefPubMedGoogle Scholar
  10. 10.
    Copray JC, Liem RS, Van Willigen JD, Ter Horst GJ. Projections from the rostral parvocellular reticular formation to pontine and medullary nuclei in the rat: involvement in autonomic regulation and orofacial motor control. Neuroscience. 1991;40(3):735.CrossRefPubMedGoogle Scholar
  11. 11.
    Nieuwenhuys R. The greater limbic system, the emotional motor system and the brain. Prog Brain Res. 1996;107:551–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Hill JM, Kaufman MP, Adreani CM. Responses of group III and IV muscle afferents to dynamic exercise. J Appl Physiol. 1997;82(6):1811–7.PubMedGoogle Scholar
  13. 13.
    Schmitz JP, Milam SB. Molecular biology of temporomandibular joint disorders: proposed mechanisms of disease. J Oral Maxillofac Surg. 1995;53:1448–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Nitzan DW. The process of lubrication impairment and its involvement in temporomandibular joint disc displacement: a theoretical concept. J Oral Maxillofac Surg. 2001;59:36–45.CrossRefPubMedGoogle Scholar
  15. 15.
    della Volpe R, Ginanneschi F, Ulivelli M, Bartalini S, Spidalieri R, Rossi A, Rossi S. Early somatosensory processing during tonic muscle pain in humans: relation to loss of proprioception and motor ‘defensive’ strategies. Clin Neurophysiol. 2003;114:1351–8.CrossRefPubMedGoogle Scholar
  16. 16.
    KowalskiO’Leary CJN, O’Leary N, Stohler CS, Turp JC. Pain maps from facial pain patients indicate a broad pain geography. J Dent Res. 1998;77(6):1465–72.CrossRefGoogle Scholar
  17. 17.
    Sherman JJ, Cunningham LL, Okeson JP, Reid KI, Carlson CR, Curran SL. Physical and sexual abuse among orofacial pain patients: linkages with pain and psychological distress. J Orofac Pain. 1995;9(4):340–6.PubMedGoogle Scholar
  18. 18.
    Burke MM, Buchwald D, Aaron LA. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia and temporomandibular disorder. Arch Intern Med. 2000;160:221–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000;47:861–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Schatman M. Psychological assessment of maldynic pain: the need for a phenomenological approach. In: Giordano J, editor. Maldynia: inter-disciplinary perspectives on the illness of chronic pain. New York: CRC Press; 2011. p. 157–82.Google Scholar
  21. 21.
    “MediLexicon”, MediLexicon International Ltd. [Online]. [Accessed 01 07 2016].Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Orofacial Pain Clinic, Joint Base San AntonioSan AntonioUSA
  2. 2.Uniformed Services University of the Health SciencesBethesdaUSA

Personalised recommendations